Provider Demographics
NPI:1396781738
Name:WRIGHT, CLIFFLORA L (LISW-S, LIDC, SAP)
Entity type:Individual
Prefix:MS
First Name:CLIFFLORA
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LISW-S, LIDC, SAP
Other - Prefix:
Other - First Name:CLIFFLORA
Other - Middle Name:AVIS
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14650 DETROIT AVENUE
Mailing Address - Street 2:SUITE LL40
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-226-2721
Mailing Address - Fax:216-226-2731
Practice Address - Street 1:14650 DETROIT AVENUE
Practice Address - Street 2:SUITE LL40
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-226-2721
Practice Address - Fax:216-226-2731
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH84104101YA0400X, 1041C0700X
OHI00022331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2736294Medicaid